Discordance in diagnosis of osteoporosis by quantitative computed tomography and dual-energy X-ray absorptiometry in Chinese elderly men

Quantitative CT lumbar spine BMD cutpoint value for classifying osteoporosis among older East Asian women should be lower than the value for Caucasians

For Caucasian women, the QCT (quantitative CT) lumbar spine (LS) bone mineral density (BMD) cutpoint value for classifying osteoporosis is 80 mg/ml. At the age of approximate 78 years, US Caucasian women QCT LS BMD population mean is 80 mg/ml, while that of Chinese women and Japanese women is around 50 mg/ml. Correlation analyses show, for Chinese women and Japanese women, QCT LS BMD of 45 mg/ml corresponds to the dual-energy X-ray absorptiometry cutpoint value for classifying osteoporosis. For Chinese and Japanese women, if QCT LS BMD 80 mg/ml is used as the threshold to classify osteoporosis, then the specificity of classifying subjects with vertebral fragility fracture into the osteoporotic group is low, whereas threshold of 45 mg/ml approximately achieve a similar separation for women with and without vertebral fragility fracture as the reports for Caucasian women. Moreover, by using 80mg/ml as the cutpoint value, LS QCT leads to excessively high prevalence of osteoporosis for Chinese women, with the discordance between hip dual-energy X-ray absorptiometry and LS QCT measures far exceeding expectation. Considering the different bone properties and the much lower prevalence of fragility fractures in the East Asian women compared with Caucasians, we argue that the QCT cutpoint value for classifying osteoporosis among older East Asian women will be close to and no more than 50 mg/ml LS BMD. We suggest that it is also imperative the QCT osteoporosis classification criterion for East Asian male LS, and male and female hips be re-examined.

MRI-based vertebral bone quality score as a novel bone status marker of patients with adolescent idiopathic scoliosis

To investigate the application of MRI-based vertebral bone quality (VBQ) score in assessing bone mineral density (BMD) for patients with adolescent idiopathic scoliosis (AIS). We reviewed the data of AIS patients between January 2021 and October 2023 with MRI, whole-spine plain radiographs, quantitative computed tomography (QCT) and general information. VBQ score was calculated using T1-weighted MRI. Univariate analysis was applied to present the differences between variables of patients with normal BMD group (QCT Z-score > - 2.0) and low BMD group (QCT Z-score ≤ - 2.0). The correlation between VBQ score and QCT Z-score was analyzed with Pearson correlation test. A multivariate logistic regression model was used to determine the independent factors related to low BMD. Receiver operating characteristic curve (ROC) was drawn to analyze the diagnostic performance of VBQ score in distinguishing low BMD. A total of 136 AIS patients (mean age was 14.84 ± 2.10 years) were included, of which 41 had low BMD. The low BMD group had a significantly higher VBQ score than that in normal group (3.48 ± 0.85 vs. 2.62 ± 0.62, P < 0.001). The VBQ score was significantly negative correlated with QCT Z score (r =  - 0.454, P < 0.001). On multivariate analysis, VBQ score was independently associated with low BMD (OR: 4.134, 95% CI 2.136-8.000, P < 0.001). The area under the ROC curve indicated that the diagnostic accuracy of the VBQ score for predicting low BMD was 81%. A sensitivity of 65.9% with a specificity of 88.4% could be achieved for distinguishing low BMD by setting the VBQ score cutoff as 3.18. The novel VBQ score was a promising tool in distinguishing low BMD in patients with AIS and could be useful as opportunistic assessment for screening and complementary evaluation to QCT before surgery.

Validation of Opportunistic Artificial Intelligence-Based Bone Mineral Density Measurements in Coronary Artery Calcium Scans

BACKGROUND

Previously we reported a manual method of measuring thoracic vertebral bone mineral density (BMD) using quantitative CT in noncontrast cardiac CT scans used for coronary artery calcium (CAC) scoring. In this report, we present validation studies of an artificial intelligence-based automated BMD measurement (AutoBMD) that recently received FDA approval as an opportunistic add-on to CAC scans.

METHODS

A deep learning model was trained to detect vertebral bodies. Subsequently, signal processing techniques were developed to detect intervertebral discs and the trabecular components of the vertebral body. The model was trained using 132 CAC scans comprising 7,649 slices. To validate AutoBMD, we used 5,785 cases of manual BMD measurements previously reported from CAC scans in the Multi-Ethnic Study of Atherosclerosis.

RESULTS

Mean ± SD for AutoBMD and manual BMD were 166.1 ± 47.9 mg/cc and 163.1 ± 46 mg/cc, respectively (P = .006). Multi-Ethnic Study of Atherosclerosis cases were 47.5% male and 52.5% female, with age 62.2 ± 10.3. A strong correlation was found between AutoBMD and manual measurements (R = 0.85, P < .0001). Accuracy, sensitivity, specificity, positive predictive value and negative predictive value for AutoBMD-based detection of osteoporosis were 99.6%, 96.7%, 97.7%, 99.7% and 99.8%, respectively. AutoBMD averaged 15 seconds per report versus 5.5 min for manual measurements (P < .0001).

CONCLUSIONS

AutoBMD is an FDA-approved, artificial intelligence-enabled opportunistic tool that reports BMD with Z-scores and T-scores and accurately detects osteoporosis and osteopenia in CAC scans, demonstrating results comparable to manual measurements. No extra cost of scanning and no extra radiation to patients, plus the high prevalence of asymptomatic osteoporosis, make AutoBMD a promising candidate to enhance patient care.

Sigmoidal relationship between liver fat content and nonalcoholic fatty liver disease in Chinese adults

PURPOSE

To explore the relationship between liver fat content (LFC) and nonalcoholic fatty liver disease (NAFLD) and determine the new threshold of LFC to diagnose NAFLD.

METHODS

The data from questionnaire survey, general physical examination, laboratory examination, and image examination were collected. Multivariate regression analysis, receiver operating characteristic curve analysis, smooth curve fitting, and threshold effect analysis were performed using the R software to investigate the relationship between LFC and NAFLD and to identify the new threshold of LFC to diagnose NAFLD.

RESULTS

The prevalence of NAFLD was 30.42%, with a significantly higher prevalence in men than in women. Regression analyses demonstrated that LFC odds ratio [95% confidence interval (CI)] was 1.28 (95% CI: 1.24-1.31) in fully-adjust model. Analysis of the LFC quartile, with Q1 as a reference, revealed that the odds ratios of NAFLD were 1.47 (95% CI: 1.08-1.99), 2.29 (95% CI: 1.72-3.06), and 10.02 (95% CI: 7.45-13.47) for Q2, Q3, and Q4 groups, respectively. Smooth curve fitting and threshold effect analysis displayed a nonlinear relationship between LFC and NAFLD, and the threshold was 4.5%. The receiver operating characteristic curve indicated that when LFC was 4.5%, the area under curve (95% CI) was 0.80 (0.79-0.82), and the sensitivity and specificity of LFC in diagnosing NAFLD were 0.64% and 0.82%, respectively.

CONCLUSION

The relationship between LFC and NAFLD was sigmoidal, with an inflection point of 4.5%.

MRI-based vertebral bone quality score for predicting cage subsidence by assessing bone mineral density following transforaminal lumbar interbody fusion: a retrospective analysis

PURPOSE

This is the first study to evaluate the predictive value of the vertebral bone quality (VBQ) score on cage subsidence after transforaminal lumbar interbody fusion (TLIF) in a Chinese population using the spinal quantitative computed tomography (QCT) as the clinical standard. Meanwhile, the accuracy of the MRI-based VBQ score in bone mineral density (BMD) measurement was verified.

METHODS

We performed a retrospective study of patients who underwent single-level TLIF from 2015 to 2020 with at least 1 year of follow-up. Cage subsidence was measured using postoperative radiographic images based on cage protrusion through the endplates more than 2 mm. The VBQ score was measured on T1-weighted MRI. The results were subjected to statistical analysis.

RESULTS

A total of 283 patients (61.1% of female) were included in the study. The subsidence rate was with 14.1% (n = 40), and the average cage subsidence was 2.3 mm. There was a significant difference in age, sex, VBQ score and spinal QCT between the subsidence group and the no-subsidence group. The multivariable analysis demonstrated that only an increased VBQ score (OR = 2.690, 95% CI 1.312-5.515, p = 0.007) and decreased L1/2 QCT-vBMD (OR = 0.955, 95% CI 0.933-0.977, p < 0.001) were associated with an increased rate of cage subsidence. The VBQ score was found to be moderately correlated with the spinal QCT (r = -0.426, p < 0.001). The VBQ score was shown to significantly predict cage subsidence, with an accuracy of 82.5%.

CONCLUSION

Our findings indicate that the MRI-based VBQ score is a significant predictor of cage subsidence and could be used to assess BMD.

Opportunistic AI-enabled automated bone mineral density measurements in lung cancer screening and coronary calcium scoring CT scans are equivalent

Rationale and objectives

We previously reported a novel manual method for measuring bone mineral density (BMD) in coronary artery calcium (CAC) scans and validated our method against Dual X-Ray Absorptiometry (DEXA). Furthermore, we have developed and validated an artificial intelligence (AI) based automated BMD (AutoBMD) measurement as an opportunistic add-on to CAC scans that recently received FDA approval. In this report, we present evidence of equivalency between AutoBMD measurements in cardiac vs lung CT scans.

Materials and methods

AI models were trained using 132 cases with 7649 (3 mm) slices for CAC, and 37 cases with 21918 (0.5 mm) slices for lung scans. To validate AutoBMD against manual measurements, we used 6776 cases of BMD measured manually on CAC scans in the Multi-Ethnic Study of Atherosclerosis (MESA). We then used 165 additional cases from Harbor UCLA Lundquist Institute to compare AutoBMD in patients who underwent both cardiac and lung scans on the same day.

Results

Mean±SD for age was 69 ± 9.4 years with 52.4% male. AutoBMD in lung and cardiac scans, and manual BMD in cardiac scans were 153.7 ± 43.9, 155.1 ± 44.4, and 163.6 ± 45.3 g/cm³, respectively (p = 0.09). Bland-Altman agreement analysis between AutoBMD lung and cardiac scans resulted in 1.37 g/cm³ mean differences. Pearson correlation coefficient between lung and cardiac AutoBMD was R² = 0.95 (p < 0.0001).

Conclusion

Opportunistic BMD measurement using AutoBMD in CAC and lung cancer screening scans is promising and yields similar results. No extra radiation plus the high prevalence of asymptomatic osteoporosis makes AutoBMD an ideal screening tool for osteopenia and osteoporosis in CT scans done for other reasons.

Quantitative CT screening improved lumbar BMD evaluation in older patients compared to dual-energy X-ray absorptiometry

BACKGROUND

Robust evidence on whether diagnostic discordance exists between lumbar osteoporosis detected by quantitative computed tomography (QCT) vs. dual-energy X-ray absorptiometry (DXA) is still lacking. In this study involving a relatively large prospective cohort of older men (aged > 60 years) and postmenopausal women, we assessed lumbar QCT-derived volumetric bone mineral density (vBMD) and DXA-derived area BMD and evaluated their predictive performance for prevalent vertebral fracture (VF).

METHODS

A total of 501 patients who underwent spinal surgery from September 2020 to September 2022 were enrolled. The criteria recommended by the American College of Radiology and the World Health Organization were used for lumbar osteoporosis diagnosis. The osteoporosis detection rates between QCT and DXA were compared. QCT-vBMD was plotted against the DXA T score, and the line of best fit was calculated based on linear regression. Multivariate logistic regression was used to analyze the associations between risk factors and VF. Receiver operating characteristic curve analysis was performed, and the corresponding area under the curve (AUC) was calculated.

RESULTS

QCT screening showed that 60.7% of patients had osteoporosis, whereas DXA screening showed that 50.7% of patients had osteoporosis. Diagnoses were concordant for 325 (64.9%) patients. In all, 205 patients suffered a VF of at least one anatomic level. Of these, 84.4% (173/205) were diagnosed with osteoporosis by QCT, while only 73.2% (150/205) were diagnosed by DXA. Multivariate logistic regression showed that osteoporosis detected by QCT exhibited a stronger relationship with VF than that detected by DXA (unadjusted OR, 6.81 vs. 5.04; adjusted OR, 3.44 vs. 2.66). For discrimination between patients with and without VF, QCT-vBMD (AUC = 0.802) showed better performance than DXA T score (AUC = 0.76).

CONCLUSION

In older patients undergoing spinal surgery, QCT-vBMD is more helpful than DXA in terms of osteoporosis detection rate and prediction of patients with prevalent VFs.

Addressing gaps in osteoporosis screening in kuwait using opportunistic quantitative computer tomography (QCT): a retrospective study

Osteoporosis is a common skeletal disorder which is underdiagnosed and undertreated. Consequent fragility fractures are associated with high morbidity and mortality. Prevention of these fractures is possible by timely osteoporosis screening followed by timely therapeutic interventions when needed. Utilizing all available modalities such as bone density measurements on preexisting CT scans could help narrow the diagnostic gap.

PURPOSE

To demonstrate the feasibility and clinical utility of opportunistic osteoporosis screening in Kuwait using QCT, aiming to increase screening rates in a country with a relatively high prevalence of osteoporosis and an alarming trend of increasing incidence of fractures.

METHODS

At a tertiary referral center, all abdominal CT scans performed on females ≥60 years old between 12/2020 and 12/2021 were retrospectively utilized for asynchronous QCT acquisition. The average volumetric bone mineral density (vBMD) was calculated, and rates of osteoporosis (vBMD < 80 mg/cm³ calcium hydroxyapatite) and osteopenia (80-120 mg/cm³) were determined. CT images were reviewed to assess for the presence of vertebral fractures. For each patient, the electronic health record was reviewed for any previous DXA scans.

RESULTS

vBMD was calculated in 305 females ≥60 years old (mean [SD] 71 [8.7], range 60-93). Low bone mass was detected in 258 patients (84.6%); 148 (48.5%) met criteria for osteopenia and 110 (36.1%) for osteoporosis. Osteoporotic vertebral fractures were observed in 64 (21.0%) study participants. Only 73 patients (23.9% of total) had a previous DXA documented in the reviewed health records. For 231 patients who were ≥65 years old, who would routinely qualify for a screening DXA, only 63 (27.3%) had a documented DXA available.

CONCLUSION

vBMD measurements obtained by opportunistic QCT had comparable rates of osteopenia and osteoporosis detection to those previously reported using DXA in a similar population in Kuwait. These findings suggest that opportunistic QCT on preexisting CT scans can be effectively utilized to narrow gaps in osteoporosis screening.

Distribution of bone voids in the thoracolumbar spine in Chinese adults with and without osteoporosis: A cross-sectional multi-center study based on 464 vertebrae

Bone void is a novel intuitive morphological indicator to assess bone quality but its use in vertebrae has not been described. This cross-sectional and multi-center study aimed to investigate the distribution of bone voids in the thoracolumbar spine in Chinese adults based on quantitative computed tomography (QCT). A bone void was defined as a trabecular net region with extremely low bone mineral density (BMD) (<40 mg/cm³), detected by an algorithm based on phantom-less technology. A total of 464 vertebrae from 152 patients (51.8 ± 13.4 years old) were included. The vertebral trabecular bone was divided into eight sections based on the middle sagittal, coronal, and horizontal planes. Bone void of the whole vertebra and each section were compared between healthy, osteopenia, and osteoporosis groups and between spine levels. Receiver operator characteristic (ROC) curves were plotted and optimum cutoff points of void volume between the groups were obtained. The total void volumes of the whole vertebra were 124.3 ± 221.5 mm³, 1256.7 ± 928.7 mm^3, and 5624.6 ± 3217.7 mm³ in healthy, osteopenia, and osteoporosis groups, respectively. The detection rate of vertebrae with bone voids was higher and the normalized void volume was larger in the lumbar than in thoracic vertebrae. L3 presented the largest void (2165.0 ± 3396.0 mm³), while T12 had the smallest void (448.9 ± 699.4 mm³). The bone void was mainly located in the superior-posterior-right section (40.8 %). Additionally, bone void correlated positively with age and increased rapidly after 55 years. The most significant void volume increase was found in the inferior-anterior-right section whereas the least increase was found in the inferior-posterior-left section with aging. The cutoff points were 345.1 mm³ between healthy and osteopenia groups (sensitivity = 0.923, specificity = 0.932) and 1693.4 mm³ between osteopenia and osteoporosis groups (sensitivity = 1.000, specificity = 0.897). In conclusion, this study demonstrated the bone void distribution in vertebrae using clinical QCT data. The findings provide a new perspective for the description of bone quality and showed that bone void could guide clinical practice such as osteoporosis screening.

Prediction of osteoporosis using radiomics analysis derived from single source dual energy CT

BACKGROUND

With the aging population of society, the incidence rate of osteoporosis is increasing year by year. Early diagnosis of osteoporosis plays a significant role in the progress of disease prevention. As newly developed technology, computed tomography (CT) radiomics could discover radiomic features difficult to recognize visually, providing convenient, comprehensive and accurate osteoporosis diagnosis. This study aimed to develop and validate a clinical-radiomics model based on the monochromatic imaging of single source dual-energy CT for osteoporosis prediction.

METHODS

One hundred sixty-four participants who underwent both single source dual-energy CT and quantitative computed tomography (QCT) lumbar-spine examination were enrolled in a study cohort including training datasets (n = 114 [30 osteoporosis and 84 non-osteoporosis]) and validation datasets (n = 50 [12 osteoporosis and 38 non-osteoporosis]). One hundred seven radiomics features were extracted from 70-keV monochromatic CT images. With QCT as the reference standard, a radiomics signature was built by using least absolute shrinkage and selection operator (LASSO) regression on the basis of reproducible features. A clinical-radiomics model was constructed by incorporating the radiomics signature and a significant clinical predictor (age) using multivariate logistic regression analysis. Model performance was assessed by its calibration, discrimination and clinical usefulness.

RESULTS

The radiomics signature comprised 14 selected features and showed good calibration and discrimination in both training and validation cohorts. The clinical-radiomics model, which incorporated the radiomics signature and a significant clinical predictor (age), also showed good discrimination, with an area under the receiver operating characteristic curve (AUC) of 0.938 (95% confidence interval, 0.903-0.952) in the training cohort and an AUC of 0.988 (95% confidence interval, 0.967-0.998) in the validation cohort, and good calibration. The clinical-radiomics model stratified participants into groups with osteoporosis and non-osteoporosis with an accuracy of 94.0% in the validation cohort. Decision curve analysis (DCA) demonstrated that the radiomics signature and the clinical-radiomics model were clinically useful.

CONCLUSIONS

The clinical-radiomics model incorporating the radiomics signature and a clinical parameter had a good ability to predict osteoporosis based on dual-energy CT monoenergetic imaging.

Discordance in lumbar bone mineral density measurements by quantitative computed tomography and dual-energy X-ray absorptiometry in postmenopausal women: a prospective comparative study

BACKGROUND CONTEXT

Level-specific lumbar bone mineral density (BMD) evaluation of a single vertebral body can provide useful surgical planning and osteoporosis management information. Previous comparative studies have primarily focused on detecting spinal osteoporosis but not at specific levels.

PURPOSE

To compare the detection rate of lumbar osteoporosis between quantitative computed tomography (QCT) and dual-energy X-ray absorptiometry (DXA); to explore and analyze the distribution models of QCT-derived BMD and DXA T-score at the specific levels; and to evaluate the diagnostic accuracy of level-specific BMD thresholds for the prediction of osteoporotic vertebral compression fracture (OVCF) in postmenopausal women.

STUDY DESIGN/SETTING

A comparative analysis of prospectively collected data comparing QCT-derived BMD with DXA T-score.

PATIENT SAMPLE

A total of 296 postmenopausal women who were referred to the spine service of a single academic institution were enrolled.

OUTCOME MEASURES

QCT-derived BMD and DXA T-score at specific levels, with or without osteoporotic vertebral compression fracture.

METHODS

Postmenopausal women who underwent QCT and DXA within a week of admission from May 2019 to June 2022 were enrolled. The diagnostic criteria for osteoporosis recommended by the World Health Organization and the American College of Radiology were used for lumbar osteoporotic diagnosis. To evaluate differences in lumbar BMD measurements at specific levels, a threshold of T score=-2.5 and QCT-derived BMD = 80 mg/cm³ were used to categorize level-specific lumbar BMD into low and high BMD. Disagreements in BMD categorization between DXA and QCT were classified as a minor or major discordance based on the definition by Woodson. Data between QCT and DXA were visualized in a stacked bar plot and analyzed. Correlations between DXA and QCT at the specific levels were evaluated using Pearson's linear correlation and scatter plots. Curve fitting of BMD distribution, receiver operating characteristic (ROC) and area under the curve (AUC) for each single vertebral level was performed.

RESULTS

Of the 296 patients, QCT diagnosed 61.1% as osteoporosis, 30.4% as osteopenia and 8.4% as normal. For those screened with DXA, 54.1% of the patients had osteoporosis, 29.4% had osteopenia and 16.6% had normal BMD. Diagnoses were concordant for 194 (65.5%) patients. Of the other 102 discordant patients, 5 (1.7%) were major and 97 (32.8%) were minor. Significant correlations in level-specific BMD between DXA and QCT were observed (p<.001), with Pearson's correlation coefficients ranging from 0.662 to 0.728. The correlation strength was in the order of L1 > L2 > L3 > L4. The low BMD detection rate for QCT was significantly higher than that for DXA at the L3 and L4 levels (65% vs. 47.9% and 68.1% vs 43.7, respectively, p<.001). Patients with OVCF showed significantly lower QCT-derived BMD (47.2 mg/cm³ vs. 83.2 mg/cm³, p<.001) and T-score (-3.39 vs. -1.98, p<.001) than those without OVCF. Among these patients, 82.8% (101/122) were diagnosed with osteoporosis by QCT measurement, while only 74.6% (91/122) were diagnosed by DXA. For discrimination between patients with and without OVCF, QCT-derived BMD showed better diagnosed performance (AUC range from 0.769 to 0.801) than DXA T-score (AUC range from 0.696 to 0.753).

CONCLUSION

QCT provided a more accurate evaluation of lumbar osteoporosis than DXA. The QCT-derived BMD measurements at a specific lumbar level have a high diagnostic performance for OVCF.

Differences in prevalence of reduced and low bone mineral density between lumbar spine and femoral neck in peritoneal dialysis patients using dual-energy X-ray absorptiometry (DXA)

The pattern of chronic kidney disease-mineral bone disease has changed following the increase in elderly patients receiving dialysis, with escalating likelihood of osteoporosis, with associated increased fracture risk and mortality. Thus, we wished to determine the prevalence of osteoporosis in our peritoneal dialysis (PD) cohort. Lumbar spine (LS) and femoral neck (FN) bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA), and low BMD (osteoporosis) and reduced BMD (osteopenia) defined according to the World Health Organisation T scores. DXA scans from 734 patients, 57.2% male, mean age 61.0 ±16.0 years, 34.6% diabetic, with a median 8.0 (2-24) months of treatment with PD were reviewed. Fewer patients had normal BMD at the FN vs. LS (24.1 vs. 55%), and more classified as reduced (FN 55.9 vs. 34% LS) and low BMD (FN 17 vs. 11% LS), χ ² 112.2, p < 0.001. Agreement between FN and LS T scores was r = 0.36 with Spearman rank correlation, and 0.34 by Kendall's tau b, Cohen's kappa score 0.17, and Bland-Altman bias -0.37 (95% limits of agreement -1.8 to 1.08). The prevalence of reduced and low BMD was much greater when using FN T scores compared to LS, with LS T scores a mean of 0.34 higher than FN. DXA scanning at the LS can be affected by overlying vascular calcification and electron densities in the bowel, and as such we suggest that FN T scores are used to report BMD in PD patients.

Opportunistic screening for osteoporosis using hydroxyapatite measurements of the vertebral by thorax dual-energy spectral CT in postmenopausal females

The purpose of this study was to evaluate the feasibility of opportunistic screening for osteoporosis in postmenopausal females using the dual-energy CT(DECT)-derived hydroxyapatite (HAP) concentration and CT value of L1-vertebra. 239 consecutive postmenopausal female patients were enrolled and underwent both chest DECT and Dual energy X-ray absorptiometry (DXA). According to the T-score of the 1st lumbar vertebra on DXA, patients were divided into the osteoporosis group (T [Formula: see text]- 2.5, n = 112) and non-osteoporosis group (T [Formula: see text] - 2.5, n = 127). The HAP values of the 1st lumbar vertebra were measured from the coronal-view HAP(Fat)-based material decomposition(MD) images, and CT values were measured on the 75 keV monochromatic image. The cutoff values of using HAP and CT value for diagnosing osteoporosis were obtained by drawing receiver operating characteristic (ROC) curves. Both HAP and CT value of the 1st lumbar vertebra had moderate-high correlation with bone-mineral-density measurement on DXA (HAP, r = 0.614; CT value, r = 0.625; all p < 0.01). The area-under-the-curve (AUC), sensitivity, specificity, PPV and NPV for diagnosing osteoporosis was 0.754, 0.714, 0.693, 0.68 and 0.752 using HAP (cutoff value: 142.05 mg/cm³) and 0.766, 0.741, 0.7, 0.685 and 0.754 using CT value (cutoff value: 132HU), respectively. HAP measurements on HAP(Fat)-based MD images in DECT could provide reasonably accurate BMD quantification for diagnosing osteoporosis in postmenopausal females. DECT prescribed for lung cancer screening could also provide opportunistic screening for osteoporosis, extending the clinical application of DECT without additional radiation to patients.

Fecal microbiota transplantation ameliorates bone loss in mice with ovariectomy-induced osteoporosis via modulating gut microbiota and metabolic function

Background

Osteoporosis (OP) is a systemic metabolic bone disease characterized by decreased bone mass and destruction of bone microstructure, which tends to result in enhanced bone fragility and related fractures. The postmenopausal osteoporosis (PMOP) has a relatively high proportion, and numerous studies reveal that estrogen-deficiency is related to the imbalance of gut microbiota (GM), impaired intestinal mucosal barrier function and enhanced inflammatory reactivity. However, the underlying mechanisms remain unclear and the existing interventions are also scarce.

Methods

In this study, we established a mouse model induced by ovariectomy (OVX) and conducted fecal microbiota transplantation (FMT) by gavage every day for 8 weeks. Subsequently, the bone mass and microarchitecture of mice were evaluated by the micro computed tomography (Micro-CT). The intestinal permeability, pro-osteoclastogenic cytokines expression, osteogenic and osteoclastic activities were detected by the immunohistological analysis, histological examination, enzyme-linked immunosorbent assay (ELISA) and western blot analysis accordingly. Additionally, the composition and abundance of GM were assessed by 16S rRNA sequencing and the fecal short chain fatty acids (SCFAs) level was measured by metabolomics.

Results

Our results demonstrated that FMT inhibited the excessive osteoclastogenesis and prevented the OVX-induced bone loss. Specifically, compared with the OVX group, FMT enhanced the expressions of tight junction proteins (zonula occludens protein 1 (ZO-1) and Occludin) and suppressed the release of pro-osteoclastogenic cytokines (tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β)). Furthermore, FMT also optimized the composition and abundance of GM, and increased the fecal SCFAs level (mainly acetic acid and propionic acid).

Conclusions

Collectively, based on GM-bone axis, FMT prevented the OVX-induced bone loss by correcting the imbalance of GM, improving the SCFAs level, optimizing the intestinal permeability and suppressing the release of pro-osteoclastogenic cytokines, which may be an alternative option to serve as a promising candidate for the prevention and treatment of PMOP in the future.

The translational potential of this article

This study indicates the ingenious involvement of GM-bone axis in PMOP and the role of FMT in reshaping the status of GM and ameliorating the bone loss in OVX-induced mice. FMT might serve as a promising candidate for the prevention and treatment of PMOP in the future.

A narrative review of the moderating effects and repercussion of exercise intervention on osteoporosis: ingenious involvement of gut microbiota and its metabolites

Osteoporosis (OP) is a systemic bone disease characterized by the decreased bone mass and destruction of bone microstructure, which tends to result in the enhanced bone fragility and related fractures, as well as high disability rate and mortality. Exercise is one of the most common, reliable and cost-effective interventions for the prevention and treatment of OP currently, and numerous studies have revealed the close association between gut microbiota (GM) and bone metabolism recently. Moreover, exercise can alter the structure, composition and abundance of GM, and further influence the body health via GM and its metabolites, and the changes of GM also depend on the choice of exercise modes. Herein, combined with relevant studies and based on the inseparable relationship between exercise intervention-GM-OP, this review is aimed to discuss the moderating effects and potential mechanisms of exercise intervention on GM and bone metabolism, as well as the interaction between them.

The potential osteoporosis due to exposure to particulate matter in ambient air: Mechanisms and preventive methods

Air pollution and health consequences associated with exposure to air pollutants, such as particulate matter, are of serious concerns in societies. Over the recent years, numerous studies have investigated the relation of many diseases with air pollutants. This review used a search strategy to provide the comprehensive information on the relationship between particle matters and osteoporosis. To this end, three search databases were used to find the articles focused on particle matters and osteoporosis. After the screening process, 13 articles related to the purpose of the study were selected and the relevant data were extracted. The results indicated that osteoporosis is significantly associated with PM₁₀. However, this association with PM_2.5 remains unclear. In addition, particle materials indirectly lead to the osteoporosis and bone fractures as a consequence of reduced UV-B, reduced adsorption of vitamin D. Furthermore, they can lead to other diseases by use of drugs with adverse effects on bone health, and creating conditions that may increase the risk of falling in the elderly. This review shows that although more accurate research is needed to determine the mechanism and risk of exposure to particulate matter in the air on bone health, the negative effects of this pollutant on bone mineral density (BMD) are evident.Implications: PM is usually classified by its size or aerodynamic diameter; PM10 denotes particles < 10 µm in diameter; PM2.5 particles are <2.5 µm in diameter. Many epidemiological studies have shown that short-term exposure to PM might reduce lung function. However, short-term effects might be reversible, and the main concern is attributed to long-term exposure. A major public health concern that may be affected by numerous metabolic and even environmental risk factors is osteoporosis. The purpose of this systematic review was to investigate the role of PM in the occurrence or exacerbation of osteoporosis in citizens.

Changes in bone mineral density after bariatric surgery in patients of different ages or patients with different postoperative periods: a systematic review and meta-analysis

To assess changes in bone mineral density (BMD) following bariatric surgery (BS) in patients with different bone sites, postoperative periods and ages. Twenty-two studies were included. Femoral neck (FN) BMD decreased after surgery (MD, - 0.05 g/cm², CI - 0.10 to - 0.01, P = 0.03). Postoperative BMD decreased more in the FN and lumbar spine (LS) of patients older than 40 (FNBMD, - 0.07 g/cm², CI - 0.13 to - 0.00, P = 0.04; LSBMD, - 0.03 g/cm², CI - 0.05 to - 0.00, P = 0.02) or patients with a postoperative time of greater than 12 months (FNBMD, - 0.06 g/cm², CI - 0.12 to - 0.01, P = 0.03; LSMD, - 0.04 g/cm², CI - 0.09 to 0.01, P = 0.12); therefore, post-BS bone loss should be monitored among patients in these groups. Longer follow-ups are needed to determine whether BMD changes or stabilizes.

Predicting Lumbar Vertebral Osteopenia Using LvOPI Scores and Logistic Regression Models in an Exploratory Study of Premenopausal Taiwanese Women

Purpose

To propose hybrid predicting models integrating clinical and magnetic resonance imaging (MRI) features to diagnose lumbar vertebral osteopenia (LvOPI) in premenopausal women.

Methods

This prospective study enrolled 101 Taiwanese women, including 53 before and 48 women after menopause. Clinical information, including age, body height, body weight and body mass index (BMI), were recorded. Bone mineral density (BMD) was measured by the dual-energy X-ray absorptiometry. Lumbar vertebral fat fraction (LvFF) was measured by MRI. LvOPI scores (LvOPISs) comprising different clinical features and LvFF were constructed to diagnose LvOPI. Statistical analyses included normality tests, linear regression analyses, logistic regression analyses, group comparisons, and diagnostic performance. A P value less than 0.05 was considered as statistically significant.

Results

The post-menopausal women had higher age, body weight, BMI, LvFF and lower BMD than the pre-menopausal women (all P < 0.05). The lumbar vertebral osteoporosis group had significantly higher age, longer MMI, and higher LvFF than the LvOPI group (all P < 0.05) and normal group (all P < 0.005). LvOPISs (AUC, 0.843 to 0.864) outperformed body weight (0.747; P = 0.0566), BMI (0.737; P < 0.05), age (0.649; P < 0.05), and body height (0.5; P < 0.05) in diagnosing LvOPI in the premenopausal women. Hybrid predicting models using logistic regression analysis (0.894 to 0.9) further outperformed all single predictors in diagnosing LvOPI in the premenopausal women (P < 0.05).

Conclusion

The diagnostic accuracy of the LvOPI can be improved by using our proposed hybrid predicting models in Taiwanese premenopausal women.

Correlation Between Bone Mineral Density (BMD) and Paraspinal Muscle Fat Infiltration Based on QCT: A Cross-Sectional Study

To investigate the correlation between fatty infiltration of the paraspinal muscle and bone mineral density (BMD). In total, 367 subjects (182 men and 185 women) who underwent quantitative computed tomography (QCT) examination were enrolled in this study. A QCT Pro workstation was used to obtain the mean BMD of the lower lumbar spine (L3, L4, L5) and fat fraction (FF) of the paraspinal muscle (psoas and erector spinae) at the corresponding levels. The patient's age, sex, body mass index, number of previous vertebral fractures, physical activity level, and visual analog scale (VAS) score for lower back pain were recorded. For categorical variables, one-way ANOVA and independent-samples t tests were performed. Spearman and Pearson correlation coefficients were used to analyze the correlations among continuous variables. Influential factors were analyzed by multivariate linear regression analysis. Regarding the mean paraspinal muscle FF, there were significant differences between the different vertebral fracture groups (P < 0.05). Age and VAS score showed a positive correlation with the mean paraspinal muscle FF (r = 0.389, 0.454). BMD showed a negative correlation with the mean paraspinal muscle FF (r =  - 0.721). The multiple linear regression analysis showed that vertebral fracture (β = 0.851, P = 0.021) and BMD (β =  - 4.341, P = 0.004) were independent factors of the mean paraspinal muscle FF. This study demonstrated that an advanced age, a greater VAS score, a higher number of vertebral fractures, and a lower BMD may be associated with more severe fatty infiltration of the paraspinal muscle.

Relationship between oseteoporosis with fatty infiltration of paraspinal muscles based on QCT examination

INTRODUCTION

To investigate the correlation between paraspinal muscles features and osteoporosis in lumbar spine.

MATERIALS AND METHODS

A total of 367 subjects who underwent quantitative computed tomography (QCT) examination were enrolled in this study. QCT pro workstation was used to obtain the mean bone mineral density (BMD) of the lower lumbar spine. Fat fraction (FF) and cross-section area (CSA) of the paraspinal muscles at the corresponding levels were measured. All participants were divided into normal, osteopenia, and osteoporosis groups. One-way ANOVA and independent samples t tests were performed to compare differences between groups. Pearson and Spearman correlation coefficients and partial correlation analysis after controlling for confounding factors were used to analyze the correlation between BMD and paraspinal muscles measurements.

RESULTS

Among the 367 participants included, 116 were in the normal group, 130 in the osteopenia group and 121 in the osteoporosis group. There were significant differences among the three groups for the mean and multifidus FF. BMD showed negative correlations with the FF of the paraspinal muscles. Multifidus and mean FF showed the best correlation (r = - 0.654, - 0.777). There were also significant differences in the mean and multifidus FF between different age groups, while after controlling for confounding factors, there was no correlation between age and FF of the paraspinal muscles.

CONCLUSION

This preliminary study demonstrated the association of BMD with fatty infiltration of paraspinal muscles. Different muscles might have specific effects in different sex and age groups.

Should Q-CT Be the Gold Standard for Detecting Spinal Osteoporosis?

STUDY DESIGN

Prospective comparative study.

OBJECTIVE

Refinement of the guidelines for screening of osteoporosis and considering quantitative computed tomography (Q-CT) for detecting spinal osteoporosis.

SUMMARY OF BACKGROUND DATA

Spinal osteoporosis is often underestimated and under-evaluated due to either lack of availability of the diagnostic modality or lack of awareness about the possibility of overestimation by dual X-ray absorptiometry (DXA) scan. There is a need for reconsidering osteoporosis evaluation with a site specific and patient specific inclination.

METHODS

Post-menopausal women that underwent bone mineral density (BMD) evaluation from January-2018 to December-2020 with either Q-CT or DXA were evaluated. Comparison studies of the distribution of age and T-scores of the bone densities obtained from the two study groups: age-matched, sex-matched, and common skeletal site of interest (L1-4 vertebrae) were performed. Mann-Whitney U test, correlation and regression analyses were performed and bell curves were plotted.

RESULTS

Of the 718 women evaluated, 447 underwent Q-CT and 271 underwent DXA. There was no significant difference among the age distribution of the two study groups (P-value > 0.05). The mean and mode T-scores obtained by Q-CT and DXA were found to be -2.71, -3.8 and -1.63, -1.7 respectively. A highly significant difference in the T-scores was observed in the Q-CT and DXA groups (P-value < 0.0001). Among those who were screened by Q-CT, 58.16% were osteoporotic, 37.58% were osteopenic, and 4.25% were normal. The respective percentages in the DXA group were 30.63%, 49.82%, and 19.55%.

CONCLUSION

Q-CT provides more precise estimation of cancellous bone mineral density than DXA. With the reliance on DXA for spinal BMD estimation being questionable, new standards have to be established for spinal osteoporosis evaluation. Q-CT can be a better alternative to replace DXA as the gold standard for the evaluation of spinal osteoporosis.Level of Evidence: 2.

Comparison of Quantitative Computed Tomography and Dual X-Ray Absorptiometry: Osteoporosis Detection Rates in Diabetic Patients

Introduction

Diabetes mellitus (DM) adversely affects the skeletal system and is associated with an increased risk of osteoporosis and fragility fractures. This study aimed to assess the diagnostic accuracy of quantitative computed tomography (QCT) in osteoporosis detection in patients with DM.

Methods

A cross-sectional diagnostic accuracy study was conducted at the diabetic clinic of a tertiary care teaching hospital in North India. A total of 30 individuals with DM were subjected to spinal QCT and lumbar spine and hip dual x-ray absorptiometry (DXA). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios of QCT were measured against DXA and the diagnostic discordance between QCT and DXA was investigated.

Results

QCT, compared to the gold standard DXA, has a sensitivity/specificity of 92.8% (95% CI 92.4%-93.2%)/81.2% (95% CI 80.6%-81.8%). The PPV/NPV of QCT was 81.2% (95% CI 80.6%-81.8%)/92.8% (95% CI 92.4%-93.2%). The positive likelihood ratio/negative likelihood ratio was 4.95 (95% CI 4.79-5.11)/0.087 (95% CI 0.082-0.093). Area under the curve was 0.871 (95% CI 0.731-1.00). Minor diagnostic discordance was present in 36.6% of patients with diabetes.

Conclusion 

The current study assessed the diagnostic accuracy of QCT in osteoporosis detection in people with diabetes. DXA is the gold standard diagnostic tool; however, its availability is limited. The current study showed that QCT is an excellent diagnostic tool. Based on these results, this study recommends that QCT may serve as a problem-solving investigation tool where DXA is unavailable, or it may be the primary investigation tool for bone mineral density measurement and osteoporosis detection if a dedicated DXA scanner is inaccessible. This study also recommends further investigating the feasibility of opportunistic osteoporosis screening in routine abdominal and chest CT. Finally, considering the silent nature of osteoporosis and the high prevalence of osteoporosis in individuals with diabetes, a proactive approach is required in the screening of osteoporosis.

The regulative effect and repercussion of probiotics and prebiotics on osteoporosis: involvement of brain-gut-bone axis

Osteoporosis (OP) is a systemic disease characterized by decreased bone mass and degeneration of bone microstructure. In recent years, more and more researches have focused on the close relationship between gut microbiota (GM) and the occurrence and progression of OP, and the regulation of probiotics and prebiotics on bone metabolism has gradually become a research hotspot. Based on the influence of brain-gut-bone axis on bone metabolism, this review expounds the potential mechanisms of probiotics and prebiotics on OP from next perspectives: regulation of intestinal metabolites, regulation of intestinal epithelial barrier function, involvement of neuromodulation, involvement of immune regulation and involvement of endocrine regulation, so as to provide a novel and promising idea for the prevention and treatment of OP in the future.

Automatic phantom-less QCT system with high precision of BMD measurement for osteoporosis screening: Technique optimisation and clinical validation

Background

Objective

Methods

Results

Conclusion

Translational potential statement

The correlation between volumetric bone mineral density and morphological parameters of the proximal femur and clinical outcomes in ankylosing spondylitis patients with hip involvement

Background

To measure volumetric bone mineral density (vBMD) with quantitative computed tomography (QCT) in the proximal femur of ankylosing spondylitis (AS) patients with hip involvement and analyze their correlations with radiographic and clinical parameters.

Methods

Sixty-five AS inpatients were enrolled in this study. The bone mineral density was measured by QCT and dual-energy x-ray absorptiometry (DXA), respectively. The morphological parameters of the proximal femur were measured on digital anteroposterior (AP) radiographs of the pelvis. The correlations between them were analyzed by SPSS software.

Results

The average trabecular vBMD measured at the femoral neck was 136.38 ± 25.58 mg/cm³. According to the BASRI-Hip score, group A consisted of 39 hips (0–2 score) and group B consisted of 26 hips (3–4 score). There were significant differences regarding trabecular CTXA equivalent T-score between group A and B at the femoral neck (p = 0.004); intertrochanteric region (p < 0.001) and greater trochanter (p = 0.001). The trabecular CTXA equivalent T-score at femoral neck had a negative correlation with disease duration (r = − 0.311, p = 0.012) and with CBR (r = − 0.319, p = 0.010).

Conclusions

The low trabecular bone density at the site of the hip was associated with the duration of disease progression and degree of hip involvement. Meanwhile, it had a correlation with hip function status although we failed to confirm a significant relationship between hip vBMD and disease activity.

The Role of Sex Hormones on Bone Mineral Density, Marrow Adiposity, and Muscle Adiposity in Middle-Aged and Older Men

PURPOSE

The etiology of age-related bone loss is less clear in men. This study is aimed to observe the variations of endogenous sex hormone concentrations with increasing of age in men, and investigate their relations to bone mass, marrow adiposity, and muscle adiposity.

METHODS

A total of 199 community-dwelling Chinese men (aged 41 to 82 years) were included and measured of serum total estradiol, total testosterone, and follicle-stimulating hormone (FSH) concentrations by enzyme-linked immunosorbent assay (ELISA). Vertebral trabecular volumetric bone mineral density (vBMD) was measured by quantitative computed tomography for all participants, and vertebral marrow fat content and erector muscle fat content were quantified by Chemistry-shift-encoding magnetic resonance imaging in 62 participants.

RESULTS

In this population, FSH concentration increased (p < 0.001) gradually with aging. Lower vBMD was independently associated with higher FSH concentration (β = -0.216, p < 0.001), but not with total estradiol or total testosterone. For each standard deviation increase in FSH there was a 50% higher risk of an individual having osteopenia or osteoporosis (vBMD < 120 mg/cm³). Marrow fat content and erector muscle fat content were greater in osteopenic and osteoporotic men, but there were no associations with sex hormones concentrations.

CONCLUSION

In summary, FSH but not total estradiol or total testosterone is related to vertebral trabecular vBMD in middle-aged and older Chinese men. Neither marrow adiposity nor muscle adiposity is associated with sex hormones.

Differences in spine volumetric bone mineral density between grade 1 vertebral fracture and non-fractured participants in the China action on spine and hip status study

PURPOSE

This study evaluated the prevalence of vertebral fractures (VF) in middle-aged and elderly Chinese men and women and explored the differences in lumbar spine volumetric bone mineral density (vBMD) derived from quantitative CT (QCT) between those with a grade 1 vertebral fracture and non-fractured individuals.

MATERIALS AND METHODS

3,457 participants were enrolled in the China Action on Spine and Hip Status (CASH) study and had upper abdominal CT examinations. Vertebral fractures were identified by Genant's semi-quantitative method from lateral CT scout views or CT sagittal views. L1-3 vBMD was measured by Mindways QCT Pro v5.0 software. The characteristics of different fracture severity groups were compared using one-way ANOVA, independent-samples t-tests, and Kruskal-Wallis H-tests.

RESULTS

1267 males (aged 62.77 ± 9.20 years) and 2170 females (aged 61.41 ± 9.01 years) were included in the analysis. In men, the prevalence of VF increased from 14.7% at age&lt;50 years to 23.2% at age ≥70 years, and in women from 5.1% at age&lt;50 years to 33.0% at age ≥70 years. Differences in mean age and vBMD were found between the different fracture grade groups. After age stratification, vBMD differences in men aged &lt; 50 years old disappeared (p = 0.162) but remained in the older age bands. There was no significant difference in mean vBMD between those with multiple mild fractures and those with a single mild fracture.

CONCLUSION

In women, the prevalence of VF increased rapidly after age 50, while it grew more slowly in men. In general, with the exception of men &lt;50 years old, participants with a grade 1 VF had lower vBMD than non-fractured individuals. The majority of women younger than 50 with a grade 1 VF had normal bone mass. We recommend that a vertebral height reduction ratio of &lt;25% be diagnosed as a deformity rather than a fracture in people under the age of 50. The presence of multiple mild fractured vertebrae does not imply lower BMD.

A phantom study comparing low-dose CT physical image quality from five different CT scanners

BACKGROUND

To systematically evaluate the physical image quality of low-dose computed tomography (LDCT) on CT scanners from 5 different manufacturers using a phantom model.

METHODS

CT images derived from a Catphan 500 phantom were acquired using manufacturer-specific iterative reconstruction (IR) algorithms and deep learning image reconstruction (DLIR) on CT scanners from 5 different manufacturers and compared using filtered back projection with 2 radiation doses of 0.25 and 0.75 mGy. Image high-contrast spatial resolution and image noise were objectively characterized by modulation transfer function (MTF) and noise power spectrum (NPS). Image high-contrast spatial resolution and image low-contrast detectability were compared directly by visual evaluation. CT number linearity and image uniformity were compared with intergroup differences using one-way analysis of variance (ANOVA).

RESULTS

The CT number linearity of 4 insert materials were as follows: acrylic (95% CI: 120.35 to 121.27; P=0.134), low-density polyethylene (95% CI: -98.43 to -97.43; P=0.070), air (95% CI: -996.16 to -994.51; P=0.018), and Teflon (95% CI: 984.40 to 986.87; P=0.883). The image uniformity values of GE Healthcare (95% CI: 3.24 to 3.83; P=0.138), Philips (95% CI: 2.62 to 3.70; P=0.299), Siemens (95% CI: 2.10 to 3.59; P=0.054), Minfound (95% CI: 2.35 to 3.65; P=0.589), and Neusoft (95% CI: 2.63 to 3.37; P=0.900) were evaluated and found to be within ±4 Hounsfield units (HU), with a range of 0.99-2.76 HU for standard deviations. There was no statistically significant difference in CT number linearity and image uniformity across the 5 CT scanners under different radiation doses with IR and DLIR algorithms (P>0.05). The resolution level at 10% MTF was 6.98 line-pairs-per-centimeter (lp/cm) on average, which was similar to the subjective evaluation results (mostly up to 7 lp/cm). DLIR at all 3 levels had the highest 50% MTF values among all reconstruction algorithms. For image low-contrast detectability, the minimum diameter of distinguishable contrast holes reached 4 mm at a 0.5% resolution. Increasing the radiation dose and IR strength reduced the image noise and NPS curve peak frequency while improving image low-contrast detectability.

CONCLUSIONS

This study demonstrated that the image quality of CT scanners from 5 different manufacturers in LDCT is comparable and that the CT number linearity is unbiased and can contribute to accurate bone mineral density quantification.

Circulating MicroRNA Expression, Vitamin D, and Hypercortisolism as Predictors of Osteoporosis in Elderly Postmenopausal Women

BACKGROUND

MicroRNAs (miRNA) identified as critical molecular regulators for bone development, function, and modeling/remodeling process and could be predictable for osteoporotic fractures in postmenopausal elderly women.

AIM

The potential diagnostic role of circulating miRNAs, miR-148a and miR-122-5p, in the pathogenesis of osteoporosis and its association with bone markers, hypercortisolism, and vitamin D deficiency were explored in postmenopausal elderly women with osteoporosis.

METHODS

A total of 120 elderly women aged 50-80 years old were recruited in this study, of which only 100 eligible women with amenorrhea of at least 12 consecutive months or surgical menopause participated in this study. Based upon bone mineral density (BMD) measurements, the participants were classified according into two groups: normal (n = 45; T score of ≥-1.0) and osteoporosis (n = 55; T score: ≤-2.5). Circulating miRNAs, miR-148a and miR-122-5p, were estimated by real-time RT-PCR analysis. In addition, bone markers, hypercortisolism, and vitamin D deficiency were colorimetrically and ELISA immune assay estimated. The potential role of miR-148a, miR-122-5p, cortisol, and vitamin D in the diagnosis of osteoporosis was predicted using the analysis of the respective area under the receiver operating characteristic curve (AUC-ROC).

RESULTS

The expressed level of miR-148a significantly increased and miR-122-5p significantly decreased in the serum of osteoporotic patients compared to healthy controls. In addition, a significant increase in the levels of cortisol, s-BAP, and CTx and significant decrease in the levels of T-BMD, the levels of OC, and s-Ca were also identified. All parameters significantly correlated with fracture risk parameters; BMD, and T score lumbar spine (L2-L4). Thus, the data showed AUC cut off values (miR-148a; 0.876, miR-122-5p; 0.761) were best evaluated for clinical diagnosis of patients with osteoporosis and that AUC cut off values of 0.748 for cortisol and 0.635 for vitamin D were the best cut off values, respectively, reported for the prediction of osteoporosis clinical diagnosis.

CONCLUSION

In this study, expressed miRNAs miR-148a and miR-122-5p and changes in the levels of both cortisol and vitamin D status are significantly associated with bone loss or osteoporosis. Thus, circulation miRNAs alone or in combination with cortisol and vitamin D status might be considered predictable biomarkers in the diagnosis or the pathogenesis of osteoporosis in elderly postmenopausal women; however, more studies are recommended.

LOXG473A induces the formation of osteoclasts in RAW264.7 cells via IL-6/JAK2/STAT3 signaling

Formation of osteoclasts is known to be closely associated with osteoporosis progression. LOX is a key enzyme that catalyzes the synthesis of collagen, which is the new mediator in osteoclast formation. However, the effect of LOXG473A on of osteoclast formation needs to be explored. Thereby, we sought to explore the effect of LOX_G473A on formation of osteoclasts and its underlying mechanism. To investigate the function of LOX_G473A in osteoclast formation, Raw264.7 cells were stably transfected with LOX-WT or LOX-MUT (LOX_G473A). Real-time PCR and western blotting were used to detect the relative levels of osteoclast formation related genes and proteins. TRAP staining and immunofluorescence staining were used to test the ability of Raw264.7 cells to form osteoclasts and the ability of cells to form rings, respectively. Bone erosion assay was used to test bone resorptive activity. The data indicated that LOX_G473A significantly enhanced the ability of osteoclasts forming, ring-forming and bone resorpting in Raw264.7 cells. Mechanically, LOX_G473A upregulated the expressions of NFATC1, ACP5, CTSK, IL-6, and the proportion of p-JAK2/JAK2 and p-STAT3/STAT3, thereby promoting the formation of osteoclasts. In conclusion, we have verified that LOX_G473A induces the proliferation of osteoclasts in Raw264.7 cells via IL-6/JAK2/STAT3 signaling, suggesting a novel strategy for studying osteoporosis.

Advancements in Osteoporosis Imaging, Screening, and Study of Disease Etiology

PURPOSE OF REVIEW

The purpose of this review is to inform researchers and clinicians with the most recent imaging techniques that are employed (1) to opportunistically screen for osteoporosis and (2) to provide a better understanding into the disease etiology of osteoporosis.

RECENT FINDINGS

Phantomless calibration techniques for computed tomography (CT) may pave the way for better opportunistic osteoporosis screening and the retroactive analysis of imaging data. Additionally, hardware advances are enabling new applications of dual-energy CT and cone-beam CT to the study of bone. Advances in MRI sequences are also improving imaging evaluation of bone properties. Finally, the application of image registration techniques is enabling new uses of imaging to investigate soft tissue-bone interactions as well as bone turnover. While DXA remains the most prominent imaging tool for osteoporosis diagnosis, new imaging techniques are becoming more widely available and providing additional information to inform clinical decision-making.

The Association of Lumbar Disc Herniation with Lumbar Volumetric Bone Mineral Density in a Cross-Sectional Chinese Study

Little is known about the effect of lumbar intervertebral disc herniation (LDH) on lumbar bone mineral density (BMD), and few previous studies have used quantitative computed tomography (QCT) to assess whether the staging of LDH correlates with lumbar vertebral trabecular volumetric bone mineral density (Trab.vBMD). To explore the relationship between lumbar Trab.vBMD and LDH, seven hundred and fifty-four healthy participants aged 20–60 years were enrolled in the study from an ongoing study on the degeneration of the spine and knee between June 2014 and 2017. QCT was used to measure L2–4 Trab.vBMD and lumbar spine magnetic resonance images (MRI) were performed to assess the incidence of disc herniation. After 9 exclusions, a total of 322 men and 423 women remained. The men and women were divided into younger (age 20–39 years) and older (age 40–60 years) groups and further into those without LDH, with a single LDH segment, and with ≥2 segments. Covariance analysis was used to adjust for the effects of age, BMI, waistline, and hipline on the relationship between Trab.vBMD and LDH. Forty-one younger men (25.0%) and 59 older men (37.3%) had at least one LDH segment. Amongst the women, the numbers were 46 (22.5%) and 80 (36.4%), respectively. Although there were differences in the characteristics data between men and women, the difference in Trab.vBMD between those without LDH and those with single and ≥2 segments was not statistically significant (p > 0.05). These results remained not statistically significant after further adjusting for covariates (p > 0.05). No associations between lumbar disc herniation and vertebral trabecular volumetric bone mineral density were observed in either men or women.

Nobiletin promotes the pyroptosis of breast cancer via regulation of miR-200b/JAZF1 axis

Nobiletin is a polymethoxylated flavone present in citrus fruits, which has been reported to have inhibitory effects on tumorigenesis of cancers. However, the biological function of nobiletin in breast cancer (BC) is largely unknown. To investigate the effect of nobiletin on growth of BC cells, the cell viability of BC was measured by MTT assay. In addition, gene and protein expressions were detected by qRT-PCR and western blot, respectively. The apoptosis and pyroptosis of BC cells were tested by flow cytometry. Finally, the correlation between miR-200b and JAZF1 was detected by dual luciferase report. The data indicated that nobiletin inhibited the proliferation of BC cells in a dose-dependent manner. Moreover, miR-200b mimics-induced pyroptosis of BC cells was further increased by nobiletin. Meanwhile, JAZF1 was found to be the target of miR-200b. Moreover, nobiletin induced apoptosis and pyroptosis of BC cells via miR-200b/JAZF1/NF-κB axis. In conclusion, nobiletin inhibited the tumorigenesis of BC via regulation of miR-200b/JAZF1 axis. Thus, nobiletin might serve as a new agent for the treatment of BC.

Opportunistic Screening Using Low-Dose CT and the Prevalence of Osteoporosis in China: A Nationwide, Multicenter Study

Opportunistic screening for osteoporosis can be performed using low-dose computed tomography (LDCT) imaging obtained for other clinical indications. In this study we explored the CT-derived bone mineral density (BMD) and prevalence of osteoporosis from thoracic LDCT in a large population cohort of Chinese men and women. A total of 69,095 adults (40,733 men and 28,362 women) received a thoracic LDCT scan for the purpose of lung cancer screening between 2018 and 2019, and data were obtained for analysis from the China Biobank Project, a prospective nationwide multicenter population study. Lumbar spine (L₁ -L₂ ) trabecular volumetric bone mineral density (vBMD) was derived from these scans using quantitative computed tomography (QCT) software and the American College of Radiology QCT diagnostic criteria for osteoporosis were applied. Geographic regional differences in the prevalence of osteoporosis were assessed and the age-standardized, population prevalence of osteoporosis in Chinese men and women was estimated from the 2010 China census. The prevalence of osteoporosis by QCT for the Chinese population aged >50 years was 29.0% for women and 13.5% for men, equating to 49.0 million and 22.8 million, respectively. In women, this rate is comparable to estimates from dual-energy X-ray absorptiometry (DXA), but in men, the prevalence is double. Prevalence varied geographically across China, with higher rates in the southwest and lower rates in the northeast. Trabecular vBMD decreased with age in both men and women. Women had higher peak trabecular vBMD (185.4 mg/cm³ ) than men (176.6 mg/cm³ ) at age 30 to 34 years, but older women had lower trabecular vBMD (62.4 mg/cm³ ) than men (92.1 mg/cm³ ) at age 80 years. We show that LDCT-based opportunistic screening could identify large numbers of patients with low lumbar vBMD, and that future cohort studies are now required to evaluate the clinical utility of such screening in terms of fracture prevention and supporting national health economic analyses. © 2020 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR)..

Bone mineral density of proximal femur in adult Chinese females

OBJECTIVE

This study was designed to establish bone mineral density (BMD) reference data of proximal femur, research the effect of age, height and weight on BMD of proximal femur, and estimate the prevalence of osteoporosis in a Chinese female population. In addition we compared the results with Lebanese and USA white women reference data.

METHODS

Our study was conducted at one center, including 1578 Chinese women, aged 20-79years. We measured the BMD for proximal femur using dual-energy X-ray absorptiometry, and then established a reference database of proximal femur and set up regression equations of age, height and weight for BMD at proximal femur to research the effects of age, height and weight on BMD. After that, we calculated the standardized BMD and compared them with Lebanese and USA white women reference data.

RESULTS

The peak BMD occurred in the age range 30-39 years for femoral neck and Ward's triangle, and 40-49 years for trochanter in Chinese women, which were later than in Lebanese and USA white women. The BMD of proximal femur in Chinese women were lower than Lebanese and USA white women in most age ranges. Weight profoundly influenced BMD in all age groups, and age and height mainly effected BMD in older age groups. The standardized prevalence of osteoporosis among Chinese women of 50-79 years old was 9.6% in femoral neck, which was higher than Lebanese but lower than USA white women.

CONCLUSION

The BMD database of proximal femur in Chinese women we established is normative and different from Lebanese and USA white women reference data, which provides more reliable information on the prevalence of osteoporosis in China.

Chinese expert consensus on the diagnosis of osteoporosis by imaging and bone mineral density

With an aging society, osteoporosis is one of the most common diseases threatening the health of China's elderly population and is an issue that is raising increasing concern. Osteoporosis is characterized by bone loss and increased susceptibility to fragility fractures. Various imaging modalities such as X-ray, CT, MRI and nuclear medicine along with assessment of bone mineral density (BMD) play an important role in its diagnosis and management, and the treatment requires multidisciplinary teamwork. A lack of consensus in the approach to imaging and BMD measurement is hampering the quality of service and patient care in China. Therefore a panel of Chinese experts from the fields of radiology, orthopedics, endocrinology and nuclear medicine reviewed the international guidelines, consensus and literature with the most recent data from China and, taking account of current clinical practice in China, the panel reached this consensus to help guide the diagnosis of osteoporosis using imaging and BMD. This consensus report provides guidelines and standards for the imaging and BMD assessment of osteoporosis and criteria for the diagnosis of osteoporosis in China.

Opportunistic osteoporosis screening in multi-detector CT images using deep convolutional neural networks

OBJECTIVE

To explore the application of deep learning in patients with primary osteoporosis, and to develop a fully automatic method based on deep convolutional neural network (DCNN) for vertebral body segmentation and bone mineral density (BMD) calculation in CT images.

MATERIALS AND METHODS

A total of 1449 patients were used for experiments and analysis in this retrospective study, who underwent spinal or abdominal CT scans for other indications between March 2018 and May 2020. All data was gathered from three different CT vendors. Among them, 586 cases were used for training, and other 863 cases were used for testing. A fully convolutional neural network, called U-Net, was employed for automated vertebral body segmentation. The manually sketched region of vertebral body was used as the ground truth for comparison. A convolutional neural network, called DenseNet-121, was applied for BMD calculation. The values post-processed by quantitative computed tomography (QCT) were identified as the standards for analysis.

RESULTS

Based on the diversity of CT vendors, all testing cases were split into three testing cohorts: Test set 1 (n = 463), test set 2 (n = 200), and test set 3 (n = 200). Automated segmentation correlated well with manual segmentation regarding four lumbar vertebral bodies (L1-L4): the minimum average dice coefficients for three testing sets were 0.823, 0.786, and 0.782, respectively. For testing sets from different vendors, the average BMDs calculated by automated regression showed high correlation (r > 0.98) and agreement with those derived from QCT.

CONCLUSIONS

A deep learning-based method could achieve fully automatic identification of osteoporosis, osteopenia, and normal bone mineral density in CT images.

KEY POINTS

• Deep learning can perform accurate fully automated segmentation of lumbar vertebral body in CT images. • The average BMDs obtained by deep learning highly correlates with ones derived from QCT. • The deep learning-based method could be helpful for clinicians in opportunistic osteoporosis screening in spinal or abdominal CT scans.